Pessary and UTIs — Prevention Guide 2026

One of the most common questions from new pessary users: does wearing a pessary cause urinary tract infections (UTIs)? The short answer: no, not directly — but a poorly-cleaned or wrong-sized pessary can raise infection risk. This 2026 prevention guide covers the real infection risk, hygiene practices proven to reduce it, symptoms to watch for, and when to see your provider.

Quick answer

Wearing a properly-fitted, properly-cleaned silicone ring pessary does NOT cause UTIs directly. However, three specific situations DO raise UTI risk:

1. Wearing a pessary continuously without cleaning it (biofilm buildup)
2. Wearing a pessary that's too large (obstructs urine flow, causes incomplete bladder emptying)
3. Wearing a pessary alongside untreated vaginal atrophy (thin tissue is more susceptible to infection)

All three are preventable. Below are the specific practices that keep UTI risk at baseline or lower.

Does a pessary cause UTIs? What the research says

Studies on pessary-associated UTI risk are mixed but converge on one point: the pessary itself is not the cause — hygiene, fit, and vaginal health are.

• A 2019 meta-analysis of pessary long-term use found UTI rates in pessary users comparable to age-matched controls when adequate hygiene was maintained.
• The largest risk factor identified: continuous wear >3 months without provider check — not the pessary itself.
• Silicone pessaries specifically have lower infection rates than the historical latex/rubber devices because silicone is non-porous and doesn't harbor bacterial biofilm the way porous latex does.

Bottom line: with correct sizing, weekly cleaning, and treatment of any coexisting vaginal atrophy, pessary users do NOT have higher UTI rates than non-users.

The 5 prevention practices that actually work

1. Clean weekly (silicone) or nightly (cube pessary)

Ring pessary cleaning schedule:

• Remove weekly (or as directed by provider)
• Wash with mild unscented soap + warm water
• Rinse thoroughly (soap residue causes irritation)
• Air dry or pat dry with clean cloth
• Store in a Pessary Storage Case ($9.99) or reinsert

Full care guide: Ring Pessary Care & Cleaning Guide.

2. Ensure your size is correct

A too-large pessary can partially obstruct the urethra, cause incomplete bladder emptying, and dramatically raise UTI risk. Signs your pessary may be too large:

• Difficulty urinating or fully emptying your bladder
• Feeling like something is still there after voiding
• Recurring UTIs after starting pessary use (2+ UTIs in 6 months when you didn't have them before)
• Discomfort or pressure high in the vagina

If any of these apply, order one size DOWN or see your provider for refitting. See our troubleshooting guide.

3. Treat vaginal atrophy alongside pessary use

Thinner vaginal tissue (common after menopause) is more susceptible to bacterial invasion. Vaginal estrogen therapy (Estrace cream, Vagifem, Imvexxy) restores tissue thickness and dramatically reduces UTI risk in postmenopausal pessary users. Discuss with your provider — local vaginal estrogen has minimal systemic effects and is safe for most women.

Non-hormonal alternative: hyaluronic acid vaginal gels (Revaree, Hyalofemme) if estrogen is contraindicated.

4. Stay hydrated and empty your bladder regularly

Standard UTI prevention, but especially important for pessary users:

• Drink 6-8 glasses of water daily
• Urinate every 3-4 hours during the day (don't hold it)
• Empty your bladder before and after sex
• Consider unsweetened cranberry supplements if you have a history of UTIs (evidence is modest but low-risk)

5. Wipe front-to-back after using the bathroom

This standard hygiene practice matters extra with a pessary because bacterial transfer to the vagina is the most common UTI mechanism.

Symptoms that suggest UTI — what to watch for

Contact your provider promptly if you experience:

• Burning or pain when urinating
• Urgency or frequency (needing to urinate every 15-30 minutes)
• Cloudy, dark, or bloody urine
• Strong-smelling urine
• Pelvic pain, back pain, or fever (fever suggests kidney infection — urgent care)
• Feeling generally unwell alongside urinary symptoms

Standard treatment is a 3-7 day course of antibiotics (nitrofurantoin, TMP-SMX, or fosfomycin depending on your provider's choice). You do NOT need to remove your pessary while being treated for UTI unless your provider specifically instructs.

What NOT to do

• Don't self-treat suspected UTIs with leftover antibiotics from prior prescriptions — antibiotic stewardship matters, and the wrong antibiotic can worsen the infection
• Don't stop using your pessary during a UTI unless your provider tells you to — removing it briefly doesn't cure the infection and may worsen prolapse symptoms
• Don't douche or use vaginal antiseptics — these disrupt normal vaginal flora and can INCREASE infection risk
• Don't use scented soaps, feminine sprays, or bubble baths — irritation raises infection risk
• Don't wear the same pessary continuously for months without cleaning — this is the single biggest risk factor

Recurrent UTIs — when to change your pessary strategy

If you experience 2+ UTIs in 6 months (or 3+ in 12 months), consider these possibilities:

1. Pessary is too large — obstructing bladder emptying. Try smaller size.
2. Untreated vaginal atrophy — start vaginal estrogen or hyaluronic acid gel.
3. Wrong pessary type — talk to provider about switching to different design (Gellhorn, donut).
4. Underlying urinary problem — pessary may not be the cause; needs urologic evaluation.
5. Try nightly removal — remove and clean nightly instead of weekly. Reduces exposure time.

Frequently asked questions

Related reading

• Ring Pessary Care & Cleaning
• Pessary Won't Stay In Troubleshooting
• Best Pessary for Menopause
• Silicone vs Latex Pessary
• Ring Pessary Side Effects